Deactivated NPI 1467443309 Deactivated / Inactive NPI Male Practitioner

Dr. Edwin F Ellis , MD

Pediatrics • Clayton, OK

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Edwin Ellis has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date October 31, 2005

NPI Deactivation Date May 17, 2023

Total Practice Duration ~18 Years of Practice (2005 – 2023)

Professional Overview & Biography Verified Profile Summary

Dr. Edwin Ellis, MD was a registered Pediatrics practicing in Clayton, OK. Throughout an active medical career spanning 18 years, Dr. Ellis provided care at the practice location at 1020 N LAWSON BOULEVARD until profile deactivation on 2023-05-17.

Historical Medicare Part B clinical services included complete blood cell count (red cells, white blood cell, platelets), automated test, blood test, comprehensive group of blood chemicals, blood test, lipids (cholesterol and triglycerides). Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

1020 N Lawson Boulevard

Clayton, OK 745360219

Telephone 9185694143

Fax 9185697552

Associated Practice Facility / Clinic

🏢 Pushmataha Family Medical Center, Inc Facility NPI 1891882676

Specialty Benchmarks & Practice Insights

Comparative analytics for Pediatrics in Clayton, OK

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 10.5 Yrs

State Avg: 22.7 Yrs

Regional Practice Density

1 Specialists

Practicing in Clayton, OK (730 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

87.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2022)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
85027 Complete blood cell count (red cells, white blood cell, platelets), automated test	140	77	$42.00	$6.42
80053 Blood test, comprehensive group of blood chemicals	116	71	$87.00	$10.23
80061 Blood test, lipids (cholesterol and triglycerides)	78	53	$148.00	$13.24
36415 Insertion of needle into vein for collection of blood sample	60	23	$20.00	$2.97
81001 Manual urinalysis test with examination using microscope, automated	52	38	$48.00	$3.08
83036 Hemoglobin A1C level	45	25	$74.00	$9.61
82043 Urine microalbumin (protein) level	39	23	$76.00	$5.72
81003 Automated urinalysis test	33	26	$25.00	$2.19
83880 Natriuretic peptide (heart and blood vessel protein) level	20	13	$192.00	$35.69
71046 X-ray of chest, 2 views	20	16	$95.00	$21.09
93005 Routine electrocardiogram (ecg) using at least 12 leads with tracing	18	15	$136.00	$5.47
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	13	11	$46.00	$6.21

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
85027 Complete blood cell count (red cells, white blood cell, platelets), automated test	210	126	$42.00	$6.42
80053 Blood test, comprehensive group of blood chemicals	185	117	$87.00	$10.46
80061 Blood test, lipids (cholesterol and triglycerides)	100	68	$147.68	$13.39
81003 Automated urinalysis test	77	52	$25.00	$2.25
83036 Hemoglobin A1C level	72	40	$74.00	$9.71
36415 Insertion of needle into vein for collection of blood sample	52	29	$20.00	$3.00
82043 Urine microalbumin (protein) level	49	29	$76.00	$5.78
81001 Manual urinalysis test with examination using microscope, automated	42	30	$48.00	$3.17
71046 X-ray of chest, 2 views	41	37	$95.00	$20.02
83880 Natriuretic peptide (heart and blood vessel protein) level	26	22	$192.00	$39.26
93005 Routine electrocardiogram (ecg) using at least 12 leads with tracing	24	21	$114.25	$5.60

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
85027 Complete blood cell count (red cells, white blood cell, platelets), automated test	249	138	$42.00	$6.34
80053 Blood test, comprehensive group of blood chemicals	198	124	$87.00	$10.35
80061 Blood test, lipids (cholesterol and triglycerides)	95	77	$147.00	$12.94
83036 Hemoglobin A1C level	89	53	$74.00	$9.27
81001 Manual urinalysis test with examination using microscope, automated	63	46	$48.00	$3.11
81003 Automated urinalysis test	61	43	$25.00	$2.16
36415 Insertion of needle into vein for collection of blood sample	52	38	$20.00	$2.87
71046 X-ray of chest, 2 views	50	39	$95.00	$19.38
82043 Urine microalbumin (protein) level	41	31	$76.00	$5.25
93005 Routine electrocardiogram (ecg) using at least 12 leads with tracing	31	25	$78.00	$7.47
83880 Natriuretic peptide (heart and blood vessel protein) level	30	25	$192.00	$36.89
86318 Test for detection of infectious agent antibody, qualitative or semiquantitative	16	15	$65.00	$16.91

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
80053 Blood test, comprehensive group of blood chemicals	351	210	$87.00	$11.32
85027 Complete blood cell count (red cells, white blood cell, platelets), automated test	331	203	$40.35	$6.94
85610 Blood test, clotting time	187	30	$36.13	$4.28
36415 Insertion of needle into vein for collection of blood sample	167	95	$19.01	$2.86
80061 Blood test, lipids (cholesterol and triglycerides)	155	120	$127.90	$14.30
81003 Automated urinalysis test	148	110	$23.65	$2.41
83036 Hemoglobin A1C level	109	64	$70.59	$10.28
83880 Natriuretic peptide (heart and blood vessel protein) level	77	46	$180.78	$38.47
71046 X-ray of chest, 2 views	74	63	$95.00	$21.51
81001 Manual urinalysis test with examination using microscope, automated	65	40	$42.92	$3.45
93005 Routine electrocardiogram (ecg) using at least 12 leads with tracing	43	35	$71.81	$7.47
82043 Urine microalbumin (protein) level	32	28	$76.00	$6.09
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	32	16	$50.00	$15.60
73562 X-ray of knee, 3 views	23	18	$87.00	$24.80
82274 Stool analysis for blood, by fecal hemoglobin determination by immunoassay	22	21	$10.00	$9.80
72100 X-ray of lower and sacral spine, 2-3 views	16	16	$94.00	$22.64
86318 Test for detection of infectious agent antibody, qualitative or semiquantitative	15	15	$65.00	$17.73
72040 X-ray of upper spine, 2-3 views	11	11	$89.00	$22.60
85379 Coagulation function measurement, d-dimer; quantitative	11	11	$139.73	$11.08

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
80053 Blood test, comprehensive group of blood chemicals	638	387	$87.00	$12.66
85027 Complete blood cell count (red cells, white blood cell, platelets), automated test	628	388	$37.00	$7.77
81003 Automated urinalysis test	327	227	$21.00	$2.67
85610 Blood test, clotting time	278	35	$34.00	$4.75
80061 Blood test, lipids (cholesterol and triglycerides)	245	193	$100.00	$16.00
J0696 Injection, ceftriaxone sodium, per 250 mg	184	19	$5.00	$0.62
83036 Hemoglobin A1C level	161	111	$62.00	$11.60
71046 X-ray of chest, 2 views	147	115	$95.00	$26.27
36415 Insertion of needle into vein for collection of blood sample	134	98	$17.00	$2.85
81001 Manual urinalysis test with examination using microscope, automated	101	78	$26.00	$3.76
83880 Natriuretic peptide (heart and blood vessel protein) level	96	80	$165.00	$41.06
93005 Routine electrocardiogram (ecg) using at least 12 leads with tracing	87	78	$59.00	$7.22
82043 Urine microalbumin (protein) level	64	55	$76.00	$7.00
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	58	23	$50.00	$17.97
83874 Myoglobin (muscle protein) level	35	34	$99.00	$15.63
84484 Troponin (protein) analysis, quantitative	35	34	$116.00	$12.22
82553 Creatine kinase (cardiac enzyme) level, mb fraction only	35	34	$52.00	$13.97
82274 Stool analysis for blood, by fecal hemoglobin determination by immunoassay	29	29	$10.00	$9.80
73620 X-ray of foot, 2 views	27	23	$70.00	$15.64
87804 Detection test by immunoassay with direct visual observation for influenza virus	23	23	$47.00	$16.22
73562 X-ray of knee, 3 views	20	19	$87.00	$22.24
87880 Detection test by immunoassay with direct visual observation for streptococcus, group a (strep)	19	19	$47.00	$15.35
73030 X-ray of shoulder, minimum of 2 views	19	17	$96.00	$16.82
73600 X-ray of ankle, 2 views	18	14	$71.00	$17.98
72100 X-ray of lower and sacral spine, 2-3 views	16	16	$94.00	$20.11
86318 Test for detection of infectious agent antibody, qualitative or semiquantitative	15	14	$65.00	$17.73
74022 Complete x-ray study of abdomen with single x-ray of chest	12	12	$120.00	$24.07
85379 Coagulation function measurement, d-dimer; quantitative	12	12	$99.00	$12.31

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
85027 Complete blood cell count (red cells, white blood cell, platelets), automated test	389	256	$36.85	$8.65
80053 Blood test, comprehensive group of blood chemicals	375	256	$84.92	$13.27
81001 Manual urinalysis test with examination using microscope, automated	149	106	$26.00	$4.26
80061 Blood test, lipids (cholesterol and triglycerides)	138	114	$97.78	$13.48
83036 Hemoglobin A1C level	122	85	$60.97	$11.42
81003 Automated urinalysis test	106	85	$21.08	$2.99
85610 Blood test, clotting time	93	25	$33.70	$5.28
71020 X-ray of chest, 2 views, front and side	90	78	$94.16	$14.43
83880 Natriuretic peptide (heart and blood vessel protein) level	76	63	$143.32	$45.03
93005 Routine electrocardiogram (ecg) using at least 12 leads with tracing	60	54	$58.67	$7.17
36415 Insertion of needle into vein for collection of blood sample	31	29	$16.94	$2.85
82043 Urine microalbumin (protein) level	26	24	$76.00	$7.17
84484 Troponin (protein) analysis, quantitative	26	26	$109.62	$13.23
83874 Myoglobin (muscle protein) level	26	26	$94.23	$17.37
82553 Creatine kinase (cardiac enzyme) level, mb fraction only	26	26	$50.69	$15.52
82274 Stool analysis for blood, by fecal hemoglobin determination by immunoassay	26	24	$44.27	$17.82
87804 Detection test by immunoassay with direct visual observation for influenza virus	17	16	$46.82	$16.11
85379 Coagulation function measurement, d-dimer; quantitative	17	17	$95.12	$13.68
73030 X-ray of shoulder, minimum of 2 views	15	15	$95.60	$16.72
72100 X-ray of lower and sacral spine, 2-3 views	15	14	$92.60	$20.46

Medical Specialties & State Licenses

Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

State License OK 8832

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners

Dr. Mitsi Faubion , DO

Family Medicine

NPI 1063408656

Doctor of Osteopathic Medicine (D.O.)

Ernest Perkins , PA-C

Physician Assistant - Medical

NPI 1417043696

Physician Assistant (Certified)

Dr. Cody Powell , DC

Chiropractor

NPI 1609350057

Doctor of Chiropractic

Dr. Bob Womack , DDS

Dentist

NPI 1619941242

Doctor of Dental Surgery

Gerald Harper , APRN-CNP

Nurse Practitioner

NPI 1730490715

Advanced Practice Registered Nurse - Certified Nurse Practitioner

Paula Brown , NP

Nurse Practitioner - Family

NPI 1992306708

Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events

⚠️

NPI Profile Deactivated May 17, 2023

Record deactivated on May 17, 2023

✅

NPI Profile Active January 12, 2015

NPI status registered as active in NPPES database

📍

Updated Practice Location January 12, 2015

Registered at 1020 N LAWSON BOULEVARD, CLAYTON, OK 745360219 (Tel: 9185694143)

📍

Updated Business Mailing Address January 12, 2015

Registered at PO BOX 219, CLAYTON, OK 745360219 (Tel: 9185694143)

👤

Provider Name / Credentials Updated January 12, 2015

Recorded as EDWIN ELLIS, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 12, 2015

Pediatrics (License #8832 in OK)

🟢

Initial NPI Registration & Enumeration October 31, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews

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NPI Administrative Meta

NPI Number: 1467443309

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: October 31, 2005

Last Update: January 12, 2015

Deactivation Date: May 17, 2023

Update or Correct Profile

Mailing Address

Po Box 219

Clayton, OK 745360219

Phone: 9185694143

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.